It has been just under 24 years since I graduated with my Bachelor’s Degree in Physical Therapy from Queen’s University in Kingston, Canada – otherwise known as the “Harvard of the North” (by everyone except McGill alumni, of course). Yes, that was back in the day when the entry level degree was a Bachelor’s Degree. Oh, those were the days. That is the topic of another upcoming post, but I digress.

I have been fortunate to practice as a physical therapist in both Canada and the United States. Physical therapy, like many other topics of discussion, shares many similarities between Canada and the United States. But there are also a number of professional issues that are very different between the two countries. I will admit, there are times when it really confuses me – how some things can be so different just by simply crossing a geopolitical border.

Here is an international perspective on our profession, with special emphasis on self image and the perception of the profession from the outside looking in.

When I was trained as a physiotherapist in Canada, I was taught the significant professional responsibilities that face our profession on a daily basis. I was taught to do what is right for the patient based on sound clinical decision-making. I was taught the limits of my scope of practice as a physiotherapist. I was taught to be involved in my professional association, with the goal of making the profession better and stronger for the benefit of the clinician and patient.

I was taught that I was an equal in the health care world – that I was not above or below a physician, a nurse, or any other provider. I was taught that I was an integral part of the health care team, and that no one member of the team was subservient to another, nor did any profession try to reign supreme over any other. That didn’t mean that there weren’t egos involved with some individuals - it simply meant that you entered into the equation as an equal contributing member of the health care team, your peers viewed you this way, and you viewed yourself (and others in your profession) accordingly.

Physiotherapists generally didn’t express disagreement amongst themselves in terms of their professional autonomy or their role in the health care arena. I was taught that physiotherapists do what physiotherapists are trained to do – nothing more, nothing less. Physiotherapists know best about the profession of physiotherapy – and that is the end of that. Frankly, I certainly wasn’t trained to be under constant negotiation with other professions about my professional autonomy.

In short, I was provided with what I would consider a fairly healthy self-image of my role as a physical therapist, as a professional, as a team member, and as an advocate for the patient. I was trained to have a healthy view of my professional autonomy – and who defines it. I also found that other health care professions responded very favorably to all of this. With that said, it is important to note that in my home province of Ontario, direct access to physical therapy has existed since 1993. I don’t think these things are coincidental.

Shortly after moving to Texas, I became a member of my professional association. Over the years, I have worked with other professions in our health care system. I have had the opportunity to watch the legislative system firsthand. I have truly enjoyed my career path as it has evolved over my time in Texas.

But there are aspects of the self image of the physical therapy profession in this country that bewilder me to this day. This is keeping in mind that the educational standards of physical therapists parallel those in my home country. Many of the group behaviors that have become acceptable over time are also incredibly self-limiting. For example, the attitude of the vast majority of gatekeepers towards physical therapists is almost a God-given imposed subservience – which befits a gatekeeper model, of course. What makes this worse is that physical therapists here seem to accept this as reality. They can’t seem to agree amongst themselves about their own professional autonomy and who defines it. Sadly, many of these self image issues have manifested themselves in many of the decisions (or lack thereof) made by the professional association over the years.

Which self image issues limit our professional growth? Are we being proactive enough? Should Vision 2020 really be Vision Now? Will we ever find agreement amongst ourselves about our professional autonomy and what shape it takes?

An upcoming article will address these issues – with what I like to call “Extreme Makeover: Physical Therapist Edition”. I hope you will join the discussion.

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Allan Besselink

Allan Besselink, PT, Dip.MDT has a unique voice in the world of sport and health care, one that has been defined by his experiences as physiotherapist, mentor, McKenzie practitioner, coach, innovator, author, educator, patient, and athlete. Read more about Allan, contact him, get updates via email, or connect with him on Twitter, Facebook, Google+ and LinkedIn.

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